Telemedicine – Hours of Experience Toward Licensure?

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Avoiding Liability Bulletin – February 2008

… How does the licensing board in your state handle the acceptability of hours of experience toward licensure as a counselor or therapist when the pre-licensed person gains hours of experience doing therapy or counseling over the Internet? Are such hours of experience prohibited? Are they permitted? If permitted, is there any limit to the number of hours that may be claimed toward licensure? Is the law silent on this issue? These are questions worthy of considering, especially for supervisors, pre-licensed persons, and licensing boards.

Some state laws may not directly address the issue of the acceptability of “Internet hours” or may be vague and it therefore may be arguable. It will depend upon the wording of the law addressing required hours of experience. Other licensing laws may prohibit such hours either directly or indirectly, while some may allow such hours (I have not researched this). Viewpoints about these kinds of hours will vary. How would a licensing board view an application for licensure that claimed that all of the required hours of experience were gained by doing online therapy? Would the board try to deny the application? Would the board have sufficient grounds to deny the application? Should the application be denied in order to protect the public? While some licensing boards may have addressed these questions, I suspect that others have not – but they certainly should.

In California, effective January 1, 2008, applicants for the marriage and family therapist license will be allowed to claim hours of experience where the psychotherapy was performed over the Internet (the practice of “telemedicine”). The bill was sponsored by the California Association of Marriage and Family Therapists and was supported by the Board of Behavioral Sciences (the licensing board). The number of hours that may be accepted is limited to 125 hours, and all telemedicine services performed must comply with another statute that mandates, among other things, verbal and written informed consent. The Association wanted to establish in statute that such hours were acceptable (the law had essentially been silent on the issue), but also wanted to limit the number of hours that could be counted toward licensure – thus preventing someone from getting all or many of their hours of experience via the Internet – perhaps never being face-to-face with a patient. Other kinds of hours, such as telephone counseling and psychological testing hours, have for a long time been similarly limited.


Richard Leslie

"At the Intersection of Law and Psychotherapy" Richard S. Leslie is an attorney who has practiced at the intersection of law and psychotherapy for the past twenty-five years. Most recently, he was a consultant to the American Association for Marriage and Family Therapy (AAMFT), where he worked with their various state divisions to develop and implement their legislative agendas. He also provided telephone consultation services to AAMFT members regarding legal and ethical issues confronting practitioners of diverse licensure nationwide. Additionally, he wrote articles regarding legal and ethical issues for their Family Therapy Magazine and presented at workshops on a variety of legal issues. Prior to his work with AAMFT, Richard was Legal Counsel to the California Association of Marriage and Family Therapists (CAMFT) for approximately twenty-two years. He was director of Government Relations for CAMFT, and as such was the architect of CAMFT’s widely regarded and successful legislative agenda. He represented CAMFT before the regulatory board (the Board of Behavioral Sciences) and was a tireless advocate for due process and fairness for licensees and applicants. He was a regular presenter at workshops and was consistently evaluated as CAMFT’s most highly rated presenter. He also sat with the CAMFT Ethics Committee and acted as their advisor on matters pertaining to the enforcement of ethical standards. Richard is an acknowledged expert on matters pertaining to the interrelationship between law and the practice of marriage and family therapy and psychotherapy. For many years, he taught Law and Ethics courses for a number of colleges and universities in their marriage and family therapy degree programs. While at CAMFT, he provided telephone consultation services with thousands of therapists in California and elsewhere for over twenty years. He is highly regarded for his judgment, his expertise, his direct style, and his clarity. Richard has been the driving force for many of the changes and additions to the laws of the State of California that affect MFTs. In 1980, he was primarily responsible for achieving passage of the "Freedom of Choice Law" that required insurance companies to pay for psychotherapy services performed by MFTs. Passage of that law allowed MFTs to earn a living, allowed them to better compete in the marketplace, and strengthened the profession in California by leading to a great increase in the number of licensees and CAMFT membership. Currently, about half of the licensed marriage and family therapists in the country are licensed in California. While at CAMFT, Richard was primarily responsible for, among other things, the successful effort to criminalize sex between a patient and a therapist. He was successful in extending the laws of psychotherapist-patient privilege to MFTs, thereby giving patients the same level of privacy protection as when seeing a psychiatrist or psychologist. He fought tirelessly and successfully for the right of MFTs to refer to themselves as "psychotherapists," to perform psychological testing services, to be appropriately reimbursed by California’s Victims of Crime Program, and to be employed in county mental health agencies throughout California. Richard was admitted to the Bar in New York (1969) and in California (1973). While practicing in New York, he served as a public defender, and later, as an Assistant District Attorney. Shortly after moving to California, he worked for the San Diego County Human Relations Commission as their Law and Justice Officer. While there, he worked successfully to achieve greater racial diversity in the criminal jury selection system and to expose and stop police abuse. For such work with that agency, he was the recipient of the Civil Libertarian of the Year Award by the San Diego Chapter of the American Civil Liberties Union.

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